1. Do you deliberately cause physical harm to yourself to the extent of causing tissue damage (breaking the skin, bruising, leaving marks that last for more than an hour)?

2. Do you cause this harm to yourself as a way of dealing with unpleasant or overwhelming emotions, thoughts, or situations (including dissociation)?

3. If your self-harm is not compulsive, do you often think about SI even when you’re relatively calm and not doing it at the moment?

If you answer #1 and #2 yes, you are a self-injurer. If you answer #3 yes, you are most likely a repetitive self-injurer. The way you choose to hurt yourself could be cutting, hitting, burning, scratching, skin-picking, banging your head, breaking bones, not letting wounds heal, among others. You might do several of these. How you injure yourself isn’t as important as recognizing that you do and what it means in your life.

If you would like do a Self Assessment Test, please go here and click on “self-assessment” in the left-hand column. The test provides you with questions and allows you to email the answers to yourself for further learning.

Why do people deliberately injure themselves?

This may be the aspect of self-harm that is most puzzling to those who do not do it. Why would anyone choose to inflict physical damage on him or herself? Because they cannot imagine themselves doing such a thing under any circumstances, many people dismiss self-injury as “senseless” or “irrational” behavior. And certainly it does seem that way at first glance.

But people generally do things for reasons that make sense to them. The reasons may not be apparent or may not fit into our frame of reference, but they exist and recognizing their existence is crucial to understanding self-harm. With understanding of the reasons behind a particular act of self-harm comes knowledge of the coping skills that are lacking. When you know what skills are missing, you can start trying to introduce them.

What self-injurers say self-injury does for them:

*Escape from emptiness, depression, and feelings of unreality.
*Easing tension.
*Providing relief: when intense feelings build, self-injurers are overwhelmed and unable to cope. By causing pain, they reduce the level of emotional and physiological arousal to a bearable one.
*Relieving anger: many self-injurers have enormous amounts of rage within. Afraid to express it outwardly, they injure themselves as a way of venting these feelings.
*Escaping numbness: many of those who self-injure say they do it in order to feel something, to know that they’re still alive.
*Grounding in reality, as a way of dealing with feelings of depersonalization and dissociation
*Maintaining a sense of security or feeling of uniqueness
*Obtaining a feeling of euphoria
*Preventing suicide
*Expressing emotional pain they feel they cannot bear
*Obtaining or maintaining influence over the behavior of others
*Communicating to others the extent of their inner turmoil
*Communicating a need for support
*Expressing or repressing sexuality
*Expressing or coping with feelings of alienation
*Validating their emotional pain — the wounds can serve as evidence that those feelings are real
*Continuing abusive patterns: self-injurers tend to have been abused as children.
*Punishing oneself for being “bad”
*Obtaining biochemical relief: there is some thought that adults who were repeatedly traumatized as children have a hard time returning to a “normal” baseline level of arousal and are, in some sense, addicted to crisis behavior. Self-harm can perpetuate this kind of crisis state
*Diverting attention (inner or outer) from issues that are too painful to examine
*Exerting a sense of control over one’s body
*Preventing something worse from happening

These reasons can be broadly grouped into three categories:

Affect regulation– Trying to bring the body back to equilibrium in the face of turbulent or unsettling feelings. This includes reconnection with the body after a dissociative episode, calming of the body in times of high emotional and physiological arousal, validating the inner pain with an outer expression, and avoiding suicide because of unbearable feelings. In many ways, as Sutton says, self-harm is a “gift of survival.” It can be the most integrative and self-preserving choice from a very limited field of options.

Communication– Some people use self-harm as a way to express things they cannot speak. When the communication is directed at others, the SIB is often seen as manipulative. However, manipulation is usually an indirect attempt to get a need met; if a person learns that direct requests will be listened to and addressed the need for indirect attempts to influence behavior decreases. Thus, understanding what an act of self-harm is trying to communicate can be crucial to dealing with it in an effective and constructive way.

Control/punishment– This category includes trauma reenactment, bargaining and magical thinking (if I hurt myself, then the bad thing I am fearing will be prevented), protecting other people, and self-control. Self-control overlaps somewhat with affect regulation; in fact, most of the reasons for self-harm listed above have an element of affect control in them.

One way to increase the chances of a distraction/substitution helping calm the urge to harm is to match what you do to how you are feeling at the moment.
1. Take a few moments and look behind the urge. What are you feeling? Are you angry? Frustrated? Restless? Sad? Craving the feeling of SI? Depersonalized and unreal or numb? Unfocused?
2. Match the activity to the feeling. A few examples:

angry, frustrated, restless
*Try something physical and violent, something not directed at a living thing:
*Slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock.
*Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.
*Flatten aluminum cans for recycling, seeing how fast you can go.
*Hit a punching bag.
*Use a pillow to hit a wall, pillow-fight style.
*Rip up an old newspaper or phone book.
*On a sketch or photo of yourself, mark in red ink what you want to do. Cut and tear the picture.
*Make Play-Doh or Sculpey or other clay models and cut or smash them.
*Throw ice into the bathtub or against a brick wall hard enough to shatter it.
*Break sticks.
*I’ve found that these things work even better if I rant at the thing I am cutting/tearing/hitting. I start out slowly, explaining why I am hurt and angry, but sometimes end up swearing and crying and yelling. It helps a lot to vent like that.
*Crank up the music and dance.
*Clean your room (or your whole house).
*Go for a walk/jog/run.
*Stomp around in heavy shoes.
*Play handball or tennis.

sad, soft, melancholy, depressed, unhappy
*Do something slow and soothing, like taking a hot bath with bath oil or bubbles, curling up under a comforter with hot cocoa and a good book, babying yourself somehow.
*Do whatever makes you feel taken care of and comforted.
*Light sweet-smelling incense.
*Listen to soothing music.
*Smooth nice body lotion into the parts or yourself you want to hurt.
*Call a friend and just talk about things that you like.
*Make a tray of special treats and tuck yourself into bed with it and watch TV or read.
*Visit a friend.

craving sensation, feeling depersonalized, dissociating, feeling unreal*Do something that creates a sharp physical sensation:
*Squeeze ice hard (this really hurts). (Note: putting ice on a spot you want to burn gives you a strong painful sensation and leaves a red mark afterward, kind of like burning would.)
*Put a finger into a frozen food (like ice cream) for a minute.
*Bite into a hot pepper or chew a piece of ginger root.
*Rub liniment under your nose.
*Slap a tabletop hard.
*Snap your wrist with a rubber band.
*Take a cold bath.
*Stomp your feet on the ground.
*Focus on how it feels to breathe. Notice the way your chest and stomach move with each breath.
[NOTE: Some people report that being online while dissociating increases their sense of unreality; be cautious about logging on in a dissociative state until you know how it affects you.]

wanting focus
*Do a task (a computer game like tetris or minesweeper, writing a computer program, needlework, etc) that is exacting and requires focus and concentration.
*Eat a raisin mindfully. Pick it up, noticing how it feels in your hand. Look at it carefully; see the asymmetries and think about the changes the grape went through. Roll the raisin in your fingers and notice the texture; try to describe it. Bring the raisin up to your mouth, paying attention to how it feels to move your hand that way. Smell the raisin; what does it remind you of? How does a raisin smell? Notice that you’re beginning to salivate, and see how that feels. Open your mouth and put the raisin in, taking time to think about how the raisin feels to your tongue. Chew slowly, noticing how the texture and even the taste of the raisin change as you chew it. Are there little seeds or stems? How is the inside different from the outside? Finally, swallow.
*Choose an object in the room. Examine it carefully and then write as detailed a description of it as you can. Include everything: size, weight, texture, shape, color, possible uses, feel, etc.
*Choose a random object, like a paper clip, and try to list 30 different uses for it.
*Pick a subject and research it on the web.

wanting to see blood*Draw on yourself with a red felt-tip pen.
*Take a small bottle of liquid red food coloring and warm it slightly by dropping it into a cup of hot water for a few minutes. Uncap the bottle and press its tip against the place you want to cut. Draw the bottle in a cutting motion while squeezing it slightly to let the food color trickle out.
*Draw on the areas you want to cut using ice that you’ve made by dropping six or seven drops of red food color into each of the ice-cube tray wells.
*Paint yourself with red tempera paint.

wanting to see scars or pick scabs
*Get a henna tattoo kit. You put the henna on as a paste and leave it overnight; the next day you can pick it off as you would a scab and it leaves an orange-red mark behind.